COVID-19: What heart patients should know

May 21, 2020

Updated May 21, 2020

In text and video, Pauley Heart Center experts share their knowledge.

The new coronavirus, COVID-19, can have serious cardiovascular impact on patients.

To learn more about the relationship between the new coronavirus and heart health, we spoke with Pauley faculty Michael Kontos, M.D., medical director of the coronary intensive care unit (CICU) and president of the Virginia Chapter of the American College of Cardiology, and Hem Bhardwaj, M.D., director of echocardiography and inpatient care. Their answers to common questions are presented below.

Are individuals with cardiovascular disease at increased risk of complications from COVID-19?

Studies have shown that patients infected with the new coronavirus who have underlying cardiovascular disease are at increased risk of dying. In addition, cardiac risk factors, specifically hypertension and diabetes, have been linked to higher risk. It is unclear if this higher risk is related specifically to these risk factors or because the patients with these risk factors tend to be older and have other chronic conditions.

It’s been suggested that COVID-19 can cause cardiac injury in otherwise healthy patients. How does the coronavirus affect the heart?

Coronavirus affects the heart indirectly, and less commonly by direct infection of the heart. An increase in a specific cardiac biomarker called troponin, which can be detected when there is an injury to the heart muscle, has been associated with a higher death rate in patients infected with COVID-19. Myocardial [heart muscle] injury likely occurs as a result of patients having underlying coronary disease who are now under significant stress from the coronavirus. Less commonly, it results from a direct effect on the heart due to the inflammatory reaction that is seen in patients with severe COVID-19.

There have been a number of reports of patients who present with ECG abnormalities consistent with an acute heart attack who, when they undergo coronary angiography, do not have significant heart blockages. This indicates that the ECG abnormalities are likely the result of an inflammation of the heart rather than a true heart attack.

What are cardiologists observing in COVID-19 patients who receive echocardiograms?

There is limited data on COVID-19 patients who have had an assessment of their heart function. In general, they have shown relatively normal function early in the course of their disease, with some patients with severe infection developing heart dysfunction. In this small group, patients who recover from the infection recover heart function, although data is limited.

Are there any treatments for COVID-19?

You may have seen in the news a number of potential treatments for COVID-19 that are currently undergoing investigation. One that has been frequently mentioned is hydroxychloroquine, which is commonly used to treat lupus, and chloroquine, which has been used to treat malaria. Although initial small studies suggested a possible benefit, more recent, larger trials have cast doubt, with some even indicating harm with treatment. Larger, randomized studies are clearly needed, as both drugs can have significant side effects. Other drugs undergoing investigation include antiviral drugs, such as remdesivir, with VCU being one of the first institutions to be included in these trials, and anti-inflammatory drugs.

What questions do your patients ask about COVID-19, and what are you telling them?

Patients often ask what symptoms to look for. Fevers, fatigue, cough and shortness of breath are common symptoms. However, gastrointestinal symptoms have also been noted. Treatment in general is symptomatic, with approximately 85% of patients infected not requiring hospitalization. Approximately 15% of patients will develop more severe symptoms that require hospitalization. Patients also ask what they can do to decrease their risk of COVID-19. Social distancing and frequent hand-washing are key.

During this pandemic, what measures are you taking to ensure heart patients stay safe but also receive any necessary clinical care?

Because of recommendations on social distancing, we're using telemedicine to provide cardiac care to outpatients while at the same time ensuring the safety of all patients and clinic staff. For those who do require further evaluation, the option of seeing a provider in the office is still available. Patients with severe symptoms should not avoid seeking care, as delay may lead to worse outcomes.

Do you have anything else you would like to add?

There has been some controversy over whether patients taking medications called angiotensin converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARBs), two common blood pressure and heart failure medications, have worse outcomes if they get COVID-19. Currently, there is no data indicating that these medications are harmful, and discontinuing them without your doctor's approval is not recommended. This is consistent with guidelines from multiple organizations, including the American College of Cardiology and the American Heart Association.